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Baby's First Tests & Procedures

As originally published on The Cradle

Your newborn is just a few minutes old, yet he’s already taking his first tests. But don’t let performance anxiety get to you. In-hospital tests are there to help doctors assess your baby’s health and to give them an earlier opportunity to discover potential (sometimes life-threatening) disorders before they adversely affect your baby’s health.

Tests vary from state to state; some are required, some are offered, but all are there to help assess the well-being of your newborn and to make sure your baby is on the right track to a healthy, happy life.

APGAR

Scored one minute after birth, and again at five minutes after birth, the APGAR assessment checks the overall condition of your baby. Even though this “test” was named after Virginia Apgar, MD, APGAR is also an acronym for Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone and neurologic alertness) and Respiration (breathing). The score given at the one-minute mark helps determine whether or not your baby needs immediate medical assistance, while the score assigned at the five-minute mark shows how your baby is progressing or responding to intervention. Scoring ranges from 0-2 for each characteristic, with 10 being the highest score. But don’t freak out - babies rarely score a 10 on this test.

HEARING SCREENING

Most states require this hearing test to be done before your baby is discharged from the hospital, but if it’s not required in your neck of the woods, try to have it done within the first three weeks of your newborn’s life. Tests are done by two methods: an ABR (auditory brainstem response) evaluation and/or OAE (otoacoustic emission). Both are fairly accurate and non-invasive (your baby can rest while the tests are being done). Using headphones, doctors are able to see how a baby responds to sound by measuring brain-wave patterns. Many hospitals wait until a baby is at least 12 hours old and administer the test when a baby is both quiet and alert. Although hearing loss is rare, early diagnosis and intervention leads to better outcomes later in life.

GLUCOSE TEST

She’s so sweet, she must be made of sugar, right? Still, some newborns are at risk for developing low blood sugar levels and need to be checked soon after birth. Most commonly, blood sugar tests are done routinely on very large babies, preterm babies, those born to mothers who had diabetes, newborns that are small for their gestational age, and after stressful deliveries. The most common way to check blood sugar is with a prick of baby’s heel, and typically blood glucose is checked at two hours of age and then up to four times a day during the first one to two days of life. Why is this test important? Prolonged low blood sugar could lead to a risk of long-term problems with development, learning, or short-term complications like poor feeding or seizures.

EXPANDED NEWBORN SCREENING

For extra peace of mind, your doctor can order additional tests that can detect upwards of 30 metabolic disorders. Done by obtaining blood with a prick to the heel, these tests include checking for phenylketonuria (PKU), congenital hypothyroidisim, maple syrup urine disease and sickle cell disease.

The American Academy of Pediatrics states that over 1,000 newborns with metabolic disorders found later in life could be identified through newborn screening. The best time to submit a specimen is when your baby is 3 to 5 days old, although it’s okay to do it when the baby is at least 24 hours old (when feeding has been established – that increases accuracy). According to americanpregnancy.org, the American Academy of Pediatrics recommends that a repeat specimen be taken one to two weeks later from infants whose initial test was taken in the first 24 hours of life.

The requirement for newborn screening varies widely from state to state — some require them, others offer them by request. Visit the National Newborn Screening & Genetics Resource Center to see what applies to your state.

EYE OINTMENT

Since there are loads of bacteria in the birth canal, many hospitals routinely administer an antibiotic ointment into a newborn’s eyes as a precaution to prevent eye infection. Although a common procedure, many parents opt not to have this intervention. The requirement of this procedure varies from hospital to hospital and is mandated in some states.

VITAMIN K

By law vitamin K has to be offered in the first hour of life. It is administered to babies as a single injection to promote blood clotting (since a deficiency of vitamin K could lead to bleeding in the brain, otherwise known as hemorrhagic disease of the newborn (HDNB) or vitamin K deficiency bleeding (VKDB). Newborns at risk for hemorrhagic disease are those who did not receive vitamin K at birth (especially those born via difficult vaginal deliveries), babies who will be exclusively breastfed and babies born to mothers who have seizure disorders.

Yet there are controversies surrounding giving a baby vitamin K. Some studies have claimed that it could possibly be linked to an increased risk of childhood leukemia, while many other studies have disputed these findings.

HEPATITIS VACCINE

It is recommended to give a dose of hepatitis-B vaccine to newborns before they leave the hospital (the law requires is that it’s at least offered during a newborn’s hospitalization). Given in a series of three vaccines, an infant (whose mother is not infected with hepatitis-B) is given the injection between birth and 2 months of age, again at least one month after the first dose, and again between 6 to 18 months of age. Again, controversially, some parents believe that hepatitis-B vaccine is linked to immunological and neurological disorders. However, there is no solid scientific evidence to support this claim.
However, if a mother’s prenatal care is consistent, and if she is healthy and not considered “high risk," the health care provider may opt not to give hep-B vaccine in the hospital and wait until the baby is 2 months of age. Talk with your pediatrician about whether or not you would like your baby to receive this vaccine.

Keep in mind that the purpose of all the above tests is to evaluate your baby's health and well-being; these assessments won’t determine whether or not your newborn will get into Harvard (there’s plenty of time to study for that). If you have any concerns or questions, discuss them with your OB, pediatrician, or genetic counselor. Be sure to weigh all your options, know what you want and don’t want, and put together a clear and informed baby care plan.

This article was reviewed by JJ Levenstein, MD, FAAP. Dr. Levenstein is a pediatrician in Encino, California.

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